- To estimate the mean change in MRI tumor volume from pretreatment to completion of preoperative endocrine therapy in estrogen receptor-positive (ER+) ductal carcinoma in situ (DCIS), as well as to determine whether 3-month change in volume correlates with 6-month change.
- To assess radiographic-pathologic correlation between MRI findings and histopathology, including the prevalence of occult invasive cancer in patients undergoing neoadjuvant endocrine therapy for DCIS.
- To compare changes in MRI maximum lesion diameter and mammographic extent at baseline and following treatment.
- To determine practice patterns of adjuvant hormonal and radiation therapy in patients who complete neoadjuvant letrozole therapy for DCIS.
- To determine whether Ki67 is reduced with neoadjuvant letrozole treatment for DCIS, and to compare the reduction in proliferation between radiographic responders and non-responders.
- To identify baseline IHC and expression biomarkers predictive of response to treatment, with response determined by extent of Ki67 reduction.
- To examine whether germline polymorphisms are associated with clinical endpoints, including treatment-related toxicity or efficacy outcomes, or with expression of biomarkers in serum or tumor.
- To assess quality-of-life and musculoskeletal symptoms associated with neoadjuvant letrozole for ER+ DCIS.
OUTLINE: This is a multicenter study.
Patients receive neoadjuvant letrozole orally (PO) once daily (QD) for 3 months. Patients then undergo MRI with an IV contrast. Patients with progressive disease discontinue letrozole and undergo surgery. Patients with complete, partial, or stable disease continue letrozole PO QD for an additional 3 months before undergoing another MRI and surgery. Patients continue receiving letrozole until the day before surgery.
Surgery (mastectomy or lumpectomy) must be performed within 30 days of the 3- or 6-month MRI.
Patients' core biopsy specimen and surgical excision specimen may be collected for correlative studies.
Patients may complete the Menopause Specific Quality-of-Life Questionnaire (MEMOQOL), the Brief Pain Inventory (BPI-SF), the Functional Assessment of Cancer Therapy - General (FACT-G), the Self-Efficacy for Coping with Side Effects, the Medication Taking Behavior (MMAS), and the Beliefs about Medicines Questionnaires at baseline and periodically during study.
After completion of study therapy, patients are followed up at 1, 3, and 6 months.
- Pathologic confirmation of ductal carcinoma in situ (DCIS) without invasive cancer of the female breast with diagnosis rendered on core biopsy only, completed within 60 days before registration
- Patients diagnosed with DCIS on the basis of surgical biopsy are not eligible for this study
- Disease stage Tis, N0, M0
- All patients must have had a diagnostic core biopsy with clip placed at time of biopsy or prior to baseline MRI
- Diagnostic tissue available for correlative studies
- DCIS must express estrogen receptor, as determined by immunohistochemical methods on the diagnostic pathology sample, according to the local institution's standard protocol
- Greater than or equal to 1% cells will be considered to be positive
- Measurable disease
- Mammographic extent of calcifications must be accurately measurable in at least one dimension with each lesion ≥ 1 cm and ≤ 5 cm
- DCIS must be visible on MRI without radiographic evidence of invasive cancer
- Patients with palpable DCIS or adenopathy are not eligible to participate
- Patients must be postmenopausal* defined as:
- Age ≥ 55 years and one year or more of amenorrhea
- Age < 55 years and one year or more of amenorrhea, with an estradiol assay < 20 pg/mL
- Surgical menopause with bilateral oophorectomy (at least 28 days must elapse from surgery to time of study registration) NOTE: *The use of GnRH analogs to achieve postmenopausal status is not allowed.
- ECOG performance status 0 or 1
- ANC ≥ 1,000/μL
- Platelet count ≥ 100,000/μL
- Serum creatinine ≤ 1.7 mg/dL
- Bilirubin ≤ 2.0 mg/dL
- AST/ALT ≤ 2.5 times upper limit of normal
- Serum estradiol level assay < 20 pg/mL
- Required for patients < 55 years of age and one year or more of amenorrhea
- Not pregnant or nursing
- No contraindications to breast MRI
- Women diagnosed with osteoporosis may participate in this trial provided they are receiving appropriate therapy
PRIOR CONCURRENT THERAPY:
- No prior surgical excision in the index breast for ductal carcinoma in situ (DCIS) or invasive cancer
- Any exogenous hormone therapy must be completed 4 weeks prior to registration
- Any patients with a history of tamoxifen or raloxifene use will be excluded
- No prior neoadjuvant/adjuvant therapy for breast cancer
Last updated: 12/18/2012